Family Planning in Asia and the Pacific - International Council on ...

As far as <strong>the</strong> supply of contraceptive commodities isconcerned, <strong>the</strong> general arrangement <strong>in</strong> <strong>the</strong> <strong>Pacific</strong> is thatUNFPA purchases <strong>and</strong> pays for contraceptives <strong>and</strong> o<strong>the</strong>rsupplies <strong>and</strong> equipment on behalf of governments fordistribution by government-operated health facilities,usually public health centres or cl<strong>in</strong>ics or, <strong>in</strong> larger centres,a dedicated reproductive health cl<strong>in</strong>ic attached to a hospitalor o<strong>the</strong>r health facility. In one or two countries, UNFPApurchases commodities on behalf of <strong>the</strong> government ona “third party” procurement arrangement, with <strong>the</strong> costscovered <strong>in</strong> <strong>the</strong> government budget. Ano<strong>the</strong>r modalityof purchase <strong>and</strong> supply is through NGOs, often <strong>Family</strong>Health Associations (FHA) affiliated with IPPF. FHAsobta<strong>in</strong> supplies through IPPF, generally at low or no cost.F<strong>in</strong>ally, <strong>in</strong> some countries, contraceptives are available <strong>in</strong>pharmacies which purchase <strong>the</strong>ir supplies from normalwholesale suppliers based overseas. Because of its highHIV prevalence rate, Papua New Gu<strong>in</strong>ea is a somewhatspecial case with several <strong>in</strong>ternational donors provid<strong>in</strong>gcondoms. O<strong>the</strong>r contraceptives <strong>and</strong> commodities areprovided through <strong>the</strong> health budget <strong>and</strong> <strong>the</strong> <strong>Family</strong><strong>Plann<strong>in</strong>g</strong> Association.In general, <strong>the</strong> distribution <strong>and</strong> dispens<strong>in</strong>g of contraceptives<strong>in</strong> <strong>the</strong> develop<strong>in</strong>g <strong>Pacific</strong> countries is based upon a threetiersystem:(a) Government-operated public health facilities associatedwith maternal <strong>and</strong> child health services or reproductivehealth cl<strong>in</strong>ics. Services are generally free <strong>and</strong> suppliesare provided by UNFPA.(b) <strong>Family</strong> Health Associations (<strong>Family</strong> WelfareAssociations <strong>in</strong> some countries) affiliated with IPPF<strong>and</strong> with supplies <strong>and</strong> commodities furnished by IPPF.O<strong>the</strong>r NGOs (such as YWCA or generic youth clubs)also distribute contraceptives <strong>and</strong> provide reproductivehealth services. In some countries NGOs are suppliedby <strong>the</strong> government, with UNFPA be<strong>in</strong>g <strong>the</strong> ultimatesupplier.(c) Private pharmacies <strong>and</strong>/or doctors <strong>in</strong> private practicewho dispense contraceptives ei<strong>the</strong>r on an over-<strong>the</strong>counterbasis or by means of prescription. Theseoutlets tend to be concentrated <strong>in</strong> urban areas.Although <strong>the</strong>re are shortcom<strong>in</strong>gs <strong>in</strong> <strong>the</strong> reliability ofcontraceptive supplies <strong>and</strong> <strong>the</strong>re is room for improv<strong>in</strong>glogistical arrangements, commodity security has greatlyimproved <strong>in</strong> recent years <strong>and</strong> <strong>the</strong> prospects for fur<strong>the</strong>rimprovement rema<strong>in</strong> quite good. As <strong>in</strong> so many o<strong>the</strong>rareas to do with <strong>the</strong> delivery of health services, PapuaNew Gu<strong>in</strong>ea is a special case. This arises from <strong>the</strong> fact thatPapua New Gu<strong>in</strong>ea rema<strong>in</strong>s a predom<strong>in</strong>antly rural, villagesociety. A significant proportion of village-based healthfacilities (aid posts) have closed <strong>in</strong> recent years due to <strong>the</strong>difficulty of ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g staff, law-<strong>and</strong>-order problems<strong>and</strong> <strong>the</strong> shortages of supplies. The extreme remotenessof so many rural villages makes commodity security verydifficult to achieve.Supply cha<strong>in</strong> <strong>and</strong> logisticsmanagementEnsur<strong>in</strong>g a secure, timely <strong>and</strong> reliable supply of contraceptivesfor all persons who wish to use <strong>the</strong>m is a strategy thathas received substantial technical <strong>and</strong> f<strong>in</strong>ancial supportover <strong>the</strong> past several years <strong>in</strong> <strong>Pacific</strong> isl<strong>and</strong> countries. Thekey organizations provid<strong>in</strong>g it are: UNFPA, AustralianAgency for <strong>International</strong> Development (AusAID), NewZeal<strong>and</strong> Agency for <strong>International</strong> Development (NZAid)<strong>and</strong> IPPF.As a result of this support, contraceptive choice hasbroadened from oral contraceptives, condoms <strong>and</strong><strong>in</strong>jectables to <strong>in</strong>clude emergency contraceptive pills,implants <strong>and</strong> female condoms. Tubal ligations are performed<strong>in</strong> many countries <strong>in</strong> urban areas, <strong>and</strong> vasectomies <strong>in</strong> a fewcountries, although dem<strong>and</strong> for <strong>the</strong> latter is low.Reproductive health policies <strong>and</strong>strategiesThe <strong>in</strong>corporation of reproductive health, <strong>in</strong>clud<strong>in</strong>g familyplann<strong>in</strong>g, <strong>in</strong>to national <strong>and</strong> subnational developmentplans <strong>and</strong> sector plans is well advanced <strong>in</strong> most <strong>Pacific</strong>isl<strong>and</strong> countries, but sexual health <strong>and</strong> family plann<strong>in</strong>g<strong>in</strong>itiatives target<strong>in</strong>g specific groups are less evident. Nearlyall develop<strong>in</strong>g <strong>Pacific</strong> isl<strong>and</strong> countries <strong>and</strong> territories(<strong>the</strong> Cook Isl<strong>and</strong>s, <strong>the</strong> Federated States of Micronesia,Fiji, Kiribati, Marshall Isl<strong>and</strong>s, Nauru, Samoa, SolomonIsl<strong>and</strong>s, Tonga, Tuvalu <strong>and</strong> Vanuatu) have developed or are<strong>in</strong> <strong>the</strong> process of develop<strong>in</strong>g national reproductive healthpolicies <strong>and</strong> strategies <strong>in</strong> which voluntary <strong>and</strong> rights-basedfamily plann<strong>in</strong>g is a core component. As DHS surveys arerecent <strong>and</strong> as yet not fully analysed, it has not been possibleto target specific groups, o<strong>the</strong>r than adolescents, whoseneeds are addressed largely by <strong>Family</strong> Health Associationsor o<strong>the</strong>r NGOs.Fund<strong>in</strong>g sourcesUNFPA is <strong>the</strong> primary fund<strong>in</strong>g source for contraceptivecommodities <strong>and</strong> o<strong>the</strong>r reproductive health supplies <strong>in</strong><strong>the</strong> smaller <strong>Pacific</strong> isl<strong>and</strong> countries. UNFPA has beenadvocat<strong>in</strong>g, with very limited success, for many yearsamong m<strong>in</strong>isters of health to <strong>in</strong>clude funds <strong>in</strong> <strong>the</strong>ir ownhealth budgets for <strong>the</strong> purchase of contraceptives. Largerisl<strong>and</strong> countries, such as Fiji <strong>and</strong> Papua New Gu<strong>in</strong>ea,purchase <strong>the</strong> bulk of <strong>the</strong>ir supplies through <strong>the</strong>ir own94